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Job Description
- Req#: 24-11095
- As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
- Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
- Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)
- Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)
- Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (10%)
- Pharmacist License of Current State
- Prior Authorization Experience.
- Medicare Experience
- Experience working in healthcare.
- Prior Authorization.
- Medicare.
- Prior Authorization Call Handling.
Job Title: Pharmacist
Location: Remote
Duration: 12+ months contract
Job Description:
Responsibilities:
Experience:
Skills:
Education:
Bachelor's Degree Required, Pharm D & Pharmacist License of Current state you are residing.
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.About the company
Our Talent Your Results - This is the premise behind US Tech Solutions. Our flexible engagement model offers right-fit talent on-demand - when, where and how you need it, so you can achieve your business objectives. We offer contingent, contract-to-hire or direct staffing services. At USTECH, we understand how critical talent is to every organization, as well as how the world of work and the workplace is changing. We offer the most effective means to help you acquire, manage and optimize talent. USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering.
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